AIDS: A Small World After All

The African HIV crisis--15 million dead, 25 million infected--hits home in Minnesota

In October of 2003, Maria Juma noticed a peculiar cold sensation in her legs. The native of Nairobi, Kenya, could also see that her feet had developed a slightly grayish pallor. Concerned that blood wasn't circulating properly through her legs, she went to see a doctor.

At the time, Juma wasn't particularly distressed about her condition. "It wasn't painful," the 35-year-old married mother of two recalls. "I was walking very strongly. I was doing everything."

The doctor was initially stumped by Juma's condition and decided to perform some blood tests. Within 24 hours the St. Paul resident received a devastating diagnosis: She had tested positive for the human immunodeficiency virus, or HIV. "I cried the whole day and the whole night," says Juma, who moved from Kenya to Minnesota four years ago to join her husband. "I didn't want to see anybody."

Juma, who would only discuss her situation on the condition that she be identified by a pseudonym, initially assumed that the diagnosis was a death sentence. Back in Kenya she'd seen dozens of people waste away and die from the disease. She recalled the fate of a cousin back in Nairobi who contracted HIV. The woman's husband left her. Her children were ostracized because they were assumed to be infected, too. Juma's family would have nothing to do with her. When the cousin eventually died from AIDS, nobody would look after her children. "They went to the streets," Juma relates. "Nobody knows where they are now."

Juma fears that she could face a similar fate. The only person that she has told about her diagnosis is her husband. He is not infected. The couple's two children are also free of the virus. Juma believes that she contracted the disease from a blood transfusion back in Kenya. Although her husband has stood by her, Juma worries that other members of the tight-knit Kenyan community in the Twin Cities will find out about her status.

"Nobody wants to associate with you," she says of people who are HIV-positive. "Not your friends, not your family, nobody. They will think I came here and started misbehaving. Then they will make me an outcast."

Juma's fear extends even to other people who are HIV-positive. She and her husband have been encouraged to join a support group for African immigrants in Minnesota living with the disease, but they are reluctant to attend. "We've never gotten the courage to go there," she says. "We just keep it to ourselves. When you tell it to other people, it will just turn out so bad for you."

Juma's predicament has become distressingly common in Minnesota in recent years. According to the Minnesota Department of Health, 21 percent of all new HIV cases in the state in 2003 were among African-born residents. Of the 266 new infections identified, 55 were among African immigrants. The numbers are particularly striking when you consider that such residents make up less than 1 percent of the state's total population.

As in Africa, women are disproportionately affected by the disease. In 2003, women represented just 24 percent of all new AIDS cases in Minnesota. By contrast, among African immigrants, just over half of reported new infected individuals were women.

"It was kind of shocking to find out that the results here in Minnesota mirrored what was happening back in Africa," says Nyango Melissa Nambangi, executive director of the Minnesota African Women's Association, a Minneapolis-based nonprofit group that has created HIV-prevention efforts aimed at African immigrants. "It was very scary to us."

For years, health officials and AIDS activists had been alarmed by the surge in HIV cases among black Minnesotans. Between 1990 and 2000, the segment of new infections represented by black residents exploded from 10 to 38 percent. But in 2001, as the number of African immigrants in the state skyrocketed, the Minnesota Department of Health created a separate category for such residents. What the agency found was striking: African immigrants accounted for 16 percent of all new HIV infections. In fact, while there continued to be a disproportionate number of African Americans afflicted with the disease, the results indicated that the epidemic had actually plateaued among native-born blacks.

It's inevitable that some African immigrants who move to Minnesota will be infected with HIV. Over the last 15 years the disease has ravaged the continent. AIDS is by far the leading cause of death in sub-Saharan Africa, with roughly 25 million people thought to be HIV-positive. It is estimated that 15 million people on the continent have already died of the disease, with the death toll rising by more than two million each year. Life expectancy has plummeted to 47 in sub-Saharan Africa. By 2010, many countries in the southern part of the continent are expected to see average life spans of under 30 years.

While the virus has not had nearly that kind of catastrophic impact in Minnesota, responding to the HIV epidemic among African-born residents has proven difficult for health care practitioners and AIDS service providers. The disease carries a heavy stigma in many African cultures. Upon being diagnosed, African immigrants are often ostracized and rejected by their friends and families. This is in large part owing to ignorance about how the disease is transmitted, with people fearing that they will be infected through routine daily interactions.

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